Healthcare Provider Details

I. General information

NPI: 1275800401
Provider Name (Legal Business Name): IVAN P. MARTINEZ, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S ANAHEIM HILLS RD 200
ANAHEIM CA
92807-4780
US

IV. Provider business mailing address

500 S ANAHEIM HILLS RD 200
ANAHEIM CA
92807-4780
US

V. Phone/Fax

Practice location:
  • Phone: 714-974-1717
  • Fax: 714-974-9019
Mailing address:
  • Phone: 714-974-1717
  • Fax: 714-974-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA25866
License Number StateCA

VIII. Authorized Official

Name: MRS. MARGARITA MARTINEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 714-974-1717